Salary Range:$70,000.00 To $75,000.00 Annually

Appeals Specialist

VetClaims.ai
Department: Appeals & Claims Advocacy
Reports To: Director of Appeals
Employment Type: Full-Time (W-2)
Location: Remote (U.S.)

Overview

The Appeals Specialist serves as the primary advocate and case manager for veterans navigating the VA appeals process. This role owns each case from intake through resolution, ensuring accuracy, compliance, and a high-quality veteran experience at every stage.

This position is critical to VetClaims.ai’s mission—transforming a complex and frustrating system into a structured, supportive, and successful journey for the veterans we serve.

Key Responsibilities

Case Ownership & Management

• Manage a full caseload of VA appeals from intake through final resolution
• Serve as the veteran’s dedicated point of contact throughout the process
• Track deadlines, milestones, and required actions to ensure timely case progression
• Maintain accurate, audit-ready documentation within CRM and internal systems

Evidence Development & Case Building

• Review VA decisions, service records, and medical evidence to identify gaps and opportunities
• Coordinate supporting documentation (nexus letters, buddy statements, lay evidence)
• Ensure all submissions meet VA standards for accuracy, completeness, and relevance

Veteran Guidance & Advocacy

• Guide veterans through each stage of the appeals process with clear next steps
• Counsel veterans on appeal options and recommend the most strategic path forward
• Identify evidentiary gaps and advise on required documentation
• Prepare veterans for exams, hearings, and VA interactions

Communication & Client Experience

• Provide proactive updates and timely responses to veteran inquiries
• Handle sensitive topics with professionalism, empathy, and discretion
• Document all communications clearly and consistently

Cross-Functional Collaboration

• Partner with C&P Prep, Fulfillment, and other departments to support case success
• Escalate complex cases, compliance risks, or legal concerns appropriately
• Contribute insights on VA trends, denial patterns, and process improvements

Compliance & Quality Assurance

• Follow all VetClaims.ai SOPs, workflows, and documentation standards
• Maintain strict confidentiality of veteran data (PII/PHI)
• Participate in QA reviews, coaching, and continuous improvement initiatives

Qualifications

• Strong organizational and case management skills
• Excellent written and verbal communication abilities
• Ability to manage multiple cases in a deadline-driven environment
• Comfortable working remotely across time zones
• Experience with VA claims or appeals processes

Working Knowledge Of:

• Supplemental Claims, Higher-Level Review, and BVA
• 38 CFR and VA rating principles
• M21-1 Adjudication Manual

Additional Experience:

• Compliance-driven or regulated environments
• CRM systems, Google Workspace, Slack, and Zoom

Key Competencies

• Attention to detail and process discipline
• Empathy and veteran-first mindset
• Critical thinking and problem-solving
• Accountability and ownership
• Ability to translate complex processes into clear guidance

Performance Metrics (KPIs)

• Case turnaround time
• Appeal success/approval rates
• Documentation accuracy and QA scores
• Veteran satisfaction and communication timeliness
• Caseload management and productivity

Why This Role Matters

The VA appeals process can take months to years and is often one of the most frustrating and overwhelming experiences veterans face after service. Many navigate it without clear guidance, sufficient evidence, or consistent advocacy—leading to delays, denials, and loss of trust.

The Appeals Specialist changes that experience.

In this role, you bring structure to chaos, clarity to complexity, and advocacy to a system that can feel impersonal. You ensure every veteran understands their path forward and has the strongest case possible.

Your work directly impacts outcomes—helping veterans secure the benefits, healthcare access, and financial support they have earned.

At VetClaims.ai, we don’t just process appeals—we fight for the people behind them. And this role is at the center of that mission.